Individual
MR. LARRY WILLIAM IMMENSCHUH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDLD
Contact information
Practice address
3009 N. W. WILSON STREET, FORT SILL, OK 73503-9042
(580) 458-2134
(580) 458-2314
Mailing address
1406 NE INDEPENDENCE AVE, LAWTON, OK 73507-3438
(580) 695-3213
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
630
OK
Other
Enumeration date
02/06/2009
Last updated
01/29/2019
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